The Court of Cassation upheld a lower court ruling Thursday that gives gives Beppino Englaro the right to remove feeding tubes that have kept his 37-year-old daughter Eluana alive since a 1992 accident left her in a vegetative state. It is a landmark decision in a country that has had several controversial right-to-die cases in the past several years.

Euthanasia is illegal in Italy, but patients do have the right to refuse treatment. The law is not clear whether patients can decline simple treatment that will lead to their deaths or, in the case of the Englaros, whether family members can decide to refuse treatment for unresponsive patients.

Beppino Englaro has been fighting since 1999 for the right to let Eluana die. He and lawyer Franca Alessio—Eluana’s court-appointed guardian—won the right in July, when the Milan Court of Appeal ruled in their favor. The court reasoned that the decision was “inevitable given the extraordinary duration of a state of permanent vegetation.” It also determined that, based on comments Eluana made before her accident, she would have wanted to die.

The Catholic Church and right-wing politicians have strongly opposed the decision, calling it euthanasia. Monsignor Rino Fisichella, president of the Vatican's Pontifical Academy for Life, told Vatican radio, “It's the gravest of decisions, involving an attack on life,” while politician Luca Volonte said, “The Cassation Court is authorising the first murder by the state.”

Eluana will be moved from the Lecco hospital that has held her for past 16 years to a hospital willing to remove her feeding tubes. Once the tubes are removed, it will take about two weeks before Eluana dies of dehydration. Beppino Englaro has said, according to the Times of London, that Eluana will be “freed from the inhumane and degrading condition in which she is forced to exist.”

Laws in Italy regarding euthanasia are contradictory and controversial; direct euthanasia is expressly forbidden, but a patient does have the right to refuse treatment. Italians are split as to whether the right to refuse treatment should be granted when it leads to the death of a patient.

In 2006, a debate about euthanasia was sparked by Piergiorgio Welby, a terminally ill patient who suffered from muscular dystrophy and needed a respirator to keep him alive. In September, he sent a video letter to Italian President Giorgio Napolitano asking for the right to die. Welby’s case was taken to court and debated in Parliament, but no clear decision could be reached.

On Dec. 20, Dr. Mario Riccio fulfilled Welby’s request, sedating him and removing the respirator. Welby died 40 minutes after the respirator was removed; Riccio was arrested, but was later cleared of euthanasia charges. “The case of Piergiorgio Welby is not a case of euthanasia,” said Riccio, according to the International Herald Tribune. “It's a case of refusing treatment.”

Italian courts have called for the legislature to create clearer laws regarding euthanasia. The Radical Party has pushed hard for laws allowing limited forms of euthanasia, but right-wing and Catholic politicians resisted it. The church has a strong position against euthanasia, believing that humans cannot determine life and death.

“Their freedom does not extend to the ending of their own lives. Euthanasia and suicide are both a rejection of God's absolute sovereignty over life and death,” writes the BBC. However, the church has said that it is “morally acceptable to refuse extraordinary and aggressive medical means to preserve life,” according to the BBC.

The Englaro case has been compared to the case of Terri Schiavo, an American woman in a persistent vegetative state who became the center of a right-to-die debate in 2005. Her husband asked doctors to remove her feeding tube, but her family took the case to court.

The case became national news, and politicians and activists from across the country argued the case. In March 2005, after seven years of bitter legal battles, Schiavo’s feeding tube was removed. She died March 31, nearly two weeks after the tube was removed.